Inositol for the Prevention of Neural Tube Defects: A Potential Opportunity for Advocacy in Global Pediatric Neurosurgery

Abstract

Objective: Approximately 70-80% of neural tube defects (NTDs) are responsive to folate. Myoinositol

has increasingly been identified as a potential solution to address folate-unresponsive

NTDs. We provide a brief background of existing evidence regarding the role of myo-inositol in

NTD prevention and describe its role in advocacy efforts focused on NTD prevention.

Methods: A narrative review was performed.

Results: Existing data regarding the efficacy of inositol supplementation is limited by low sample

sizes and primarily observational study designs. Although advocacy efforts regarding NTDs have

focused on folate fortification and supplementation, examining the data for inositol intake is

worthwhile. After reviewing the data, we put forth that a series of criteria would need to be met

even before considering advocacy and policy. First, the weight of evidence must favor increasing

inositol intake. Second, the cost-effectiveness of inositol policy must be demonstrated. Third, the

policy must be politically viable. Fourth, political priority for the policy must be generated. Fifth,

synergy between existing folate policy efforts and inositol policy efforts must be generated. After

that series of criteria are examined, advocacy may occur through neurosurgery-specific

organizations, combined approaches with other surgical disciplines, and advocacy through

collaborations of various clinical and research personnel.

Conclusion: Inositol may represent an avenue for reducing the birth prevalence of folateunresponsive

neural tube defects. Given their clinical roles in treatment of spina bifida